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Importance of functional performance and psychological readiness for return to preinjury level of sports 1 year after ACL reconstruction in competitive athletes

  • Takuya KitaguchiEmail author
  • Yoshinari Tanaka
  • Shinya Takeshita
  • Nozomi Tsujimoto
  • Keisuke Kita
  • Hiroshi Amano
  • Kazutaka Kinugasa
  • Yuta Tachibana
  • Takashi Natsuume
  • Shuji Horibe
KNEE
  • 123 Downloads

Abstract

Purpose

This study aimed to identify independent predictive factors for return to sports (RTS) after anterior cruciate ligament (ACL) reconstruction in competitive-level athletes and to determine optimal cut-off values for these factors at 6 months after surgery.

Methods

A total of 124 competitive athletes (50 males and 74 females; mean age, 17.0 years; preinjury Tegner activity scale > 7) who underwent primary ACL reconstruction were enrolled. Assessments at 6 months after surgery consisted of knee functional tests [quadriceps index, hamstrings index, and single-leg hop for distance (SLH)] and 2 self-report questionnaires [IKDC subjective score and ACL-Return to Sport after Injury scale (ACL-RSI)]. At 1 year after surgery, athletes were classified into the RTS group (n = 101) or non-RTS group (n = 23) based on self-reported sports activities. After screening possible predictive factors of RTS, multivariate logistic regression and receiver operating characteristic curve analyses were performed to identify independent factors.

Results

Multivariate logistic regression analysis identified SLH (odds ratio, 2.861 per 10 unit increase; P < 0.001) and ACL-RSI (odds ratio, 1.810 per 10 unit increase; P = 0.001) at 6 months as independent predictors of RTS at 1 year after surgery. Optimal cut-off values of SLH and ACL-RSI were 81.3% (sensitivity = 0.891; specificity = 0.609) and 55 points (sensitivity = 0.693; specificity = 0.826), respectively.

Conclusion

In competitive athletes, SLH < 81% and ACL-RSI < 55 points at 6 months after surgery were associated with a greater risk of unsuccessful RTS at 1 year after surgery. SLH and ACL-RSI at 6 months could serve as screening tools to identify athletes who have difficulties with returning to sports after ACL reconstruction.

Level of evidence

III.

Keywords

Anterior cruciate ligament Reconstruction Return to sports Predictive factor Cut-off value 

Abbreviations

ACL

Anterior cruciate ligament

ACL-RSI

Anterior Cruciate Ligament-Return to Sport after Injury scale

AUC

Area under the curve

BTB

Bone–patellar tendon–bone

HI

Hamstrings index

LSI

Limb symmetry index

QI

Quadriceps index

ROC

Receiver operating characteristic

RTS

Return to sports

SLH

Single-leg hop for distance

Notes

Funding

No funding has been received for this study.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to declare.

Ethical approval

This study was approved by the Ethics Committee of Osaka Rosai Hospital (ID.29-21).

Informed consent

Informed consent was obtained from all subjects.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Takuya Kitaguchi
    • 1
    Email author
  • Yoshinari Tanaka
    • 2
  • Shinya Takeshita
    • 1
  • Nozomi Tsujimoto
    • 1
  • Keisuke Kita
    • 3
  • Hiroshi Amano
    • 4
  • Kazutaka Kinugasa
    • 2
  • Yuta Tachibana
    • 2
  • Takashi Natsuume
    • 1
  • Shuji Horibe
    • 5
  1. 1.Department of RehabilitationOsaka Rosai HospitalOsakaJapan
  2. 2.Department of Sports OrthopaedicsOsaka Rosai HospitalOsakaJapan
  3. 3.Department of Orthopaedics SurgeryJCHO Osaka Hospital, OsakaOsakaJapan
  4. 4.Department of Sports OrthopaedicsAamano Orthopaedics Clinic, OsakaOsakaJapan
  5. 5.Faculty of Comprehensive RehabilitationOsaka Prefecture UniversityOsakaJapan

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